Topic #3: Physical Therapy and the ACA

Why don’t we talk about something a little more fun today? Yep, I’m talking about fun with Obamacare! The law itself is incredible dense and complex, so I’m only going over things that can directly relate to physical therapy. If you want to read more on healthcare reform, I suggest taking a long vacation and reading the entire document (but really, don’t do that).

Originally discussed and passed by Congress in 2010, the Patient Protection and Affordable Care Act, or ACA, was under intense scrutiny and ultimately argued in front of the Supreme Court. In 2012, the Court ruled in favor of implementing most changes of the ACA. Since this ruling, many changes have already been implemented that current physical therapists have seen. But what are these changes, and what kind of changes are yet to come for physical therapy?

GraphicEHBExchangesMedicaid_710x549            Possibly the most widespread change brought about by healthcare reform is the individual mandate, which essentially requires all Americans to hold some form of health insurance. This was an important facet of President Obama’s reform to help stymie rising healthcare costs, as taxpayers would previously have had to pay for uninsured hospital coverage. Prior to the ACA, individuals could remain uninsured with no penalty. This was and continues to be a very controversial topic within Congress. So much so that its implementation has been delayed until 2016. Many believe healthcare is a fundamental right (in support of the ACA), while others believe healthcare is a privilege (opposed to the ACA). This portion of reform was passed with the notion that all Americans have a right to healthcare coverage, regardless of personal income or pre-existing conditions.

For physical therapy, this has several implications. Ideally, the more people who have health insurance, the more patients we may see. While that’s all well and good, if more people seek physical therapy, insurance companies may reduce reimbursement in order to maintain profits. This is already in effect for many private insurers, as many of you may have seen. Many clinics are making up for decreased reimbursement by seeing more and more patients per day, straining physical therapists who are already pressured by insurance companies to document every detail and use arcane timed codes to get paid.

While that seems like a bleak outlook for our profession, there are more abstract changes occurring that actually greatly benefit physical therapy in the long run. For one, prevention and wellness services are on the forefront of future changes in healthcare. The National Association of Insurance Commissioners

naic            made a sweeping definition of habilitative services, which are “Healthcare services that help a person keep, learn, or improve skills and functioning for daily living…these services may include physical and occupational therapy, speech-language pathology, and other services for people with disabilities in a variety of inpatient and/or outpatient settings.” These habilitative services fall under one of 10 categories of healthcare that insurance companies are required to provide. In this case, habilitative services fall under Essential Health Benefits. States have the individual option to define habilitative services, and the qualitative benefits associated with those services. Many states have adopted the NAIC’s definition above, or created a very similar definition. The important part is that some form of physical therapy services are now covered under the ACA.

So what is the APTA’s take on the recent changes? This statement by the APTA President, Paul Rockar, gives an optimistic opinion of future changes in healthcare for physical therapy. APTA leadership is also taking the lead on several initiatives to increase recognition and reimbursement for physical therapy. Justin Moore spoke to my class recently, and stated that the physical therapist’s role in healthcare “has changed from a service to a profession.” If this distinction is made in the minds of our patients, the idea is that physical therapy will become an individual form of their healthcare, rather than the view that many providers can perform physical therapy. Right now, “physical therapy” isn’t even a protected term in most states, meaning other professions (i.e. chiropractic) can advertise that they provide physical therapy. The shift to a “profession” rather than a “service” can also lay the foundation for more freedom in practice and increased reimbursement under the ACA.

With all the changes occurring in healthcare right now, it’s impossible to discuss all of them in one sitting. However, there are also changes we are not even aware of. Time will ultimately tell how these changes will impact providers, consumers, and physical therapists. In the meantime, I believe physical therapy is gaining significant traction, and is in position to become one of the best healthcare sectors in our country in the near future. The ACA is providing the platform for physical therapists to jump into the forefront of conservative and preventative care, which can reduce healthcare costs nationwide.


About 535advocacy

I'm a physiotherapist with a passion for politics. After working for several years in Student Senate and Government Affairs, I found that most people don't care about politics, because they don't know how to get involved. Now, it's my goal to change that.
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